674 Effect of a best-practice alert on the rates of smoking cessation during pregnancy

Abstract

Both the US Public Health Service and ACOG recommend that clinicians offer effective tobacco dependence interventions to pregnant smokers at first prenatal visit and throughout the pregnancy. However, in a busy practice, counseling may occur at first but may not be reinforced at each subsequent prenatal visit while the patient continues to smoke. The objective of this study was to determine the effect of a best-practice alert (BPA) on counseling and smoking cessation rates in pregnancy. In 2018, we created and added a BPA to our electronic prenatal record. The BPA let providers know at each prenatal visit if patient is still an active smoker and provided the 5A’s method summary for counseling on smoking cessation. We then compared the rates of smoking cessation in pregnancy 1 year before and after BPA. Secondary outcomes examined were documentation of smoking cessation counseling in the chart and rates of obstetric outcomes associated with tobacco smoking. Pre-post comparisons were done with unadjusted models and multivariable backward logistic regressions. After BPA implementation, the rates of smoking cessation in pregnancy increased from 18.4% prior to BPA implementation to 52.6% after BPA implementation (p<0.001, OR 4.93, 95%CI 3.26-7.57). Documentation of counseling in the chart increased as well (Table1). In multivariable analyses, controlling for maternal demographic and clinical factors, BPA was significantly associated with higher odds of smoking cessation in pregnancy (aOR 3.44, 95% CI 2.17-5.51) and documentation of counseling (aOR 12.44, 95% CI 6.06-25.64) (Table 2). The rates of most obstetric outcomes examined did not differ between the pre- and post-BPA groups except preterm prelabor rupture of membranes which was significantly reduced in the post-BPA group (aOR 0.33, 95% CI 0.12-0.80). The rate of smoking cessation in pregnancy and counseling documentation during prenatal visits increased after implementation of the BPA. We recommend adding a smoking cessation BPA to electronic prenatal records to increase smoking cessation rates during pregnancy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)